We have heard an excellent lecturer whose only fault, we think, was

want of liveliness and variety. Few men could in other respects lecture

comparably to him. Nothing could surpass the quiet, polished manner

of this accomplished teacher. His voice, though not good, was by no

means unpleasing. His articulation elaborately distinct, and free from

all provincialism. His language invariably correct and appropriate;

the structure of his sentences strikingly grammatical; and they fell

in such an easy, though somewhat too rhythmical succession, as to be

at once graceful and melodious. His arrangement, always simple and

clear. Nothing was more striking than the deferential manner in which

he approached a philosophical subject. "I like ——," said one who

had often heard him, "because he is always so gentlemanly. There is

nothing off-hand, as if he thought himself very clever, but a kind of

unaffected respect for himself and his audience, which obliges one to

pay attention to him, if it were only because you feel that a man of

education is speaking to you."

What, it may be said, can such a man want? Why he wanted liveliness

and flexibility. His voice measured forth its gentlemanly way with

all the regularity of a surveying rod. Various and interesting as his

subjects were, and handled with consummate ability, he must certainly

have _taught_; yet we think he sent away many of his audience passive

recipients, as distinguished from persons _set on thinking_ what they

had heard "into their own."

He performed his task like a good man and a scholar; but still it was

like a task after all. It was something like a scholar reading a book,

always excepting the beautifully clear illustrations for which his

subject gave him abundant opportunity. He wanted that animation and

interest in his subject by which a lecturer inoculates you with his own

enthusiasm. He was the most striking example in our experience of the

importance of liveliness and variety, and of making a lecture, however

well delivered, just that thing which we _cannot_ find in a book. The

life-like, the dramatic effect was wanting; and it was to this alone

that we can ascribe what we have not unfrequently observed in the midst

of a generally attentive audience, a few who were "nodding" their

assent to his propositions.

Now Abernethy's manner was perfect in these respects. He had just got

the "cheerfully, not too fast" expression, that we sometimes see at

the head of a musical composition. His manner was so good, that it

is difficult to convey any idea of it. It was easy, without being

negligent; cheerful, without being excited; humorous, often witty,

without being vulgar; expeditious, without being in a bustle; and he

usually took care that you should learn _the thing_, before he gave the

_name of it_; and understand it, before he expatiated on the beauty or

perfection of its adaptation to the ends it seemed designed to serve.

He was particularly chaste in the manner in which he spoke of design,

or other of the Attributes so frequently observable in natural

arrangements. It is a great mistake, we think, and not without

something akin to vulgarity, to usher in any description of the

beauties of nature by a flourish of such trumpets as human epithets

form—mere notes of admiration. Nature speaks best for herself. The

mind is kept in a state of excitement by too frequent _feux de joies_

of this kind; the frequent recurrence of such terms as "curious!

strange! wonderful!" on subjects where all is wonderful, have a sort of

bathos in the ears of the judicious, while to the less critical they

produce a kind of disturbed atmosphere, which is unfavourable to the

calm operations of the intellect.

Abernethy was generally very careful in these matters. I give one

example. He is speaking of cartilage, or gristle, which covers the

ends of the bones where they form joints, and has explained its great

elasticity, the use of it in preventing jarring; and contrasted the

_springiness_ of youth with the easily jarred frame of age. "Well,"

he adds, "this cartilage is fibrous, and they say that the fibres are

arranged vertically; so that the body may be said to be supported on

'_myriads of elastic columns_.'" That was the beauty by which he wished

to impress that which he had previously _taught_.

When marvellousness is too much excited, many say, "Ah, how clever

that gentleman is! what an interesting lecture! what a curious thing

that was he showed us!" But when you inquire what _principle_ or _law_

was intended to be illustrated, you find that the sensual or the

imaginative faculty has alone been excited, and has galloped off with

that which was intended for the intellect. If persons are examined as

to a particular point of the lecture, they are apt to say: "Well, that

is just what I wanted to know; would you explain it?"

It would seem that it is a great mistake to excite marvellousness

or our external senses very vividly, when we desire to concentrate

the intellectual faculties. That breathless silence, with eyes and

mouth open, that "_intenti que ora tenebant_" condition, excited by

marvellousness, is very well for the story of Æneas, or Robinson

Crusoe; but it is out of place, when we are endeavouring to augment our

intellectual possessions.

We require, in fact, a calmer atmosphere. The desire to interest and

hold the attention of our audience is so natural, that it is very apt

to escape one that this may be done _on terms not consistent_ with our

real object—the interesting the intellect; and this fault is perhaps,

of all, the worst; because it is never a greater failure than when it

appears to be successful. All other faults in lecturing, if serious, in

one respect tell their own tale in the thinning audience.

The learned author of the "Philosophy of Rhetoric" has observed that "A

discourse directed to the understanding will not admit of an address to

the passions, which, as it never fails to disturb the operation of the

intellectual faculty, must be regarded by every intelligent hearer as

foreign indeed, if not insidious." He had before said, "that in such a

discourse you may borrow metaphor or comparison to illustrate it, but

not the bolder figures, prosopopœia and the like, which are intended

not to elucidate the subject, but to _create admiration_."

"It is obvious," he continues, "that either of the foregoing, far from

being subservient to the main design (to address the intellect), serves

only to distract the attention from it[67]."

This judicious writer, however, in the first sentence makes a

distinction, which requires, perhaps, to be received with some caution.

There is no discourse that is solely intellectual; the driest

mathematical proposition interests our _feelings_. The pleasure of

truth, what is that? Not merely intellectual, certainly. It is a

pleasure derived _from_ the intellect, no doubt; but it is a _feeling_

entirely distinct. So, in addresses to the passions, if they are

successful, the presiding influence of the intellect is very obvious;

this away, a discourse soon merges into bombast or fustian, a something

which neither impresses the feelings nor the passions as desired.

The true desideratum, as it appears to us, is accuracy of adjustment,

not separation. In intellectual operations, the feelings are to be

subservient to the accomplishment of the objects of the intellect. In

discourses, where the passions or feelings are most appealed to, or

most prominent, the intellect must still really guide, though it may

appear to follow.

Notwithstanding that so much of Abernethy's lecturing was on anatomy,

and therefore necessarily addressed to the eye, yet he seldom offered

any _illustration_ to the external senses. He was always endeavouring

to impress the mechanical arrangement of parts, by reference to their

uses and surgical relations. Even in speaking of light, he would be

suggestive beyond the mere perception of sense. He used to say, of

refraction of light, when the refracting medium was, as it commonly

is, the denser body, "that the ray seems as if attracted"—a very

suggestive phrase to any one who has thought much on the subject of

light. It is a curious thing to observe how confused the ideas of many

people are on phenomena of light; and we are afraid that the cause is,

that the illustrations to the eye are given _too soon_. If people were

made to _understand_ by a simple illustration what they are about to

_see_, it is probable they would have much clearer ideas. The intellect

having gone before, the eye no longer diverts it from its office; and

the eye would then be merely _impressing_, by means of a physical

representation, an established idea.

[Footnote 67: Vol. i, p. 23.]

CHAPTER XXIII.

"Suavis autem est et vehementer sæpe utilis jocus et facetiæ."—CIC.

DE ORAT.

Abernethy's humour was very peculiar; and though there was of course

something in the matter, there was a good deal more, as it appeared

to us, in the manner. The secret of humour, we apprehend, lies in the

juxtaposition, either expressed or implied, of incongruities, and it is

not easy to conceive anything humourous which does not involve these

conditions. We have sometimes thought there was just this difference in

the humour of Abernethy, as contrasted with that of Sidney Smith. In

Smith's, there was something that, told by whom it might be, was always

ludicrous. Abernethy's generally lay in the telling.

"The jest's propriety lies in the ear

Of him who hears it, never in the tongue

Of him that makes it,"

although true, was still to be taken in rather a different sense from

that in which it is usually received. The former (a far higher species

of humour) may be recorded; the dramatic necessities of the other

occasion it to die with the author. The expression Abernethy threw into

his humour (though of course without that broadness which is excusable

in the drama, but which would have been out of place in a philosophical

discourse) was a quiet, much-subdued colouring, between the good-nature

of Dowton, and (a little closer perhaps to the latter) the more quiet

and gentlemanly portions of Munden.

Few old pupils will forget the story of the Major who had dislocated

his jaw.

This accident is a very simple one, and easily put right; but, having

once happened, it is apt to recur on any unusual extension of the lower

jaw. Abernethy used to represent this as a frequent occurrence with

an hilarious Major; but as it generally happened at mess, the surgeon

went round to him and immediately put it in again. One day, however,

the Major was dining about fourteen miles from the regiment, and, in a

hearty laugh, "out went his jaw." They sent for the medical man, whom,

said Abernethy, we must call the apothecary. Well, at first, he thought

that the jaw was dislocated; but he began to pull and to show that he

knew nothing about the proper mode of putting it right again. On this,

the Major appeared to be very excited, and vociferated inarticulately

in a strange manner; when, all at once, the doctor, as if he had just

hit on the nature of the case, suggested that the Major's complaint was

in his brain, and that he could not be in his right mind. On hearing

this, the Major became furious, which was regarded as confirmatory of

the doctor's opinion; they accordingly seized him, confined him in

a strait-waistcoat and put him to bed, and the doctor ordered that

the barber should be sent for to shave the head, and a blister to be

applied "to the part affected."

The Major, fairly beaten, ceased making resistance, but made the

best signs his situation and his imperfect articulation allowed, for

pen and paper. This request, being hailed as indicative of returning

rationality, was complied with; and, as soon as he was sufficiently

freed from his bonds, he wrote—"For God's sake send for the surgeon of

the regiment." This was accordingly done, and the jaw readily reduced,

as it had been often before. "I hope," added Abernethy, "you will never

forget how to reduce a dislocated jaw."

We think that what we have said of the style of his humour cannot be

very incorrect, from knowing that the impressions of one of his oldest

pupils and greatest admirers were almost identical with the foregoing.

I recollect it being said of John Bannister, that the reason his acting

pleased everybody was that he was always a gentleman; an extremely

difficult thing, we should imagine, in handling some of the freer parts

of our comic dialogues. Abernethy's humour (exceptionally indeed, but

occasionally a little broad) never suggested the idea of vulgarity;

and, as we have said, every joke had its mission. Then, at times,

though there was not much humour, yet a promptness of repartee gave it

that character.

"Mr. Abernethy," said a patient, "I have something the matter, sir,

with this arm. There, oh! (making a particular motion with the limb)

that, sir, gives me great pain." "Well, what a fool you must be to do

it, then," said Abernethy.

One of the most interesting facts in relation to Abernethy's lecturing,

was, that however great his natural capacity, he certainly owed very

much to careful study and practice; and we cannot but think that it

is highly encouraging to a more careful education for this mode of

teaching, to know the difficulty that even such a man as Abernethy had

for some few years in commanding his self-possession. To those who only

knew him in his zenith or his decline, this will appear extraordinary;

yet, to a careful observer, there were many occasions when it was

easy to see that he did not appear so entirely at ease _without some

effort_. He was very impatient of interruption; an accidental knock

at the door of the theatre, which, by mistake of some stranger, would

occasionally happen, would disconcert him considerably; and once,

when he saw some pupil joking or inattentive, he stopped, and with a

severity of manner I hardly ever saw before or afterwards, said: "If the

lecture, sir, is not interesting to you, I must beg you to walk out."

There were, as we shall hereafter observe, perhaps physical reasons

for this irritability. He never hesitated, as we occasionally hear

lecturers do, nor ever used any notes. When he came to any part that

he perhaps wished to impress, he would pause and think for a second

or two, with his class singularly silent. It was a fine moment. We

recollect being once at his lecture with the late Professor Macartney,

who had been a student of Abernethy's[68]. Macartney said, "what can

it be that enables him to give so much interest to what we have so

often heard before?" We believe it to have been nothing but a steady

observance of rules, combined with an admirable power _matured by

study_.

That which, above everything, we valued in the whole of Abernethy's

lectures, was what can hardly be expressed otherwise than by the

term, tone. With an absence of all affectation, with the infusion

of all sorts of different qualities: with humour, hilarity, lively

manner, sometimes rather broad illustrations, at other times, calm

and philosophical, with all the character of deep thought and acute

penetration; indignation at what was wrong or unfeeling, and pathos in

relation to irremediable calamity; still the thing which surpassed all,

was the feeling, with which he inoculated the pupils, of a high and

conscientious calling. He had a way which excited enthusiasm without

the pupil knowing why. We are often told by lecturers of the value of

knowledge for various purposes—for increasing the power and wealth of

the country—for multiplying the comforts and pleasures of society—for

amassing fortunes, and for obtaining what the world usually means by

the term distinction. But Abernethy created a feeling distinct from and

superior to all mere utilitarian purposes. He made one feel the mission

of a conscientious surgeon to be a high calling, and spurned, in manner

as well as matter, the more trite and hackneyed modes of inculcating

these things. You had no set essay, no long speeches. The _moral_

was like a golden thread artfully interwoven in a tissue to which it

gives a diffusive lustre; which, pervading it everywhere, is obtrusive

nowhere.

For example, the condition attached to the performance of our lowest

duties (operations), were, the well-ascertained inefficacy of our

best powers directed to judicious treatment; the _crowning_ test—the

conviction that, placed in the same circumstances, _we would have the

same operation performed on ourselves_. Much of the suggestive lies

in these directions. Our sympathies toward the victims of mistake or

ignorance, excited by the relation of their sufferings, were heightened

by the additional mention of any good quality the patient might have

possessed, or advantage of which he might have been deprived; and thus

that interest secured which a bare narration of the case might have

failed to awaken.

A father, who, in subservience to the worldly prospects of his son,

placed him in a situation to which he was unequal, and thus forgot his

first duty, the health of his offspring, was the "murderer" of his

child. Another victim, we have seen, was as "brave a fellow as ever

stepped," &c.

Humanity and Science went hand in hand. His method of _discovering_

the nature of dislocations and fractures, by attention to the relative

position of parts, was admirable; and few of his pupils, who have

had much experience, have failed to prove the practical excellence

of them. He repudiated nothing more than the too commonly regarded

test, in fractures, of "grating, or crepitus." Nothing distinguished

his examination of a case more than his gentleness, unless it was the

clearness with which he delivered his opinion.

To show how important gentleness is—a surgeon had a puzzling case

of injury to the elbow. He believed that he knew the nature of the

accident, and that he had put the parts right; but still the joint

remained in a half-straight position; and the surgeon, who knew his

business, became alarmed, lest something had escaped him, and that

the joint would be stiff. He proposed a consultation. The joint was

examined with great gentleness, and after Abernethy's plan. The boy

experienced no pain. Everything appeared in its natural position. The

surgeon said: "Now, my boy, bend your arm a little, but no farther

than just to reach my finger; and not as much as that, if it gives you

any pain." This the boy did very gently. After waiting a few minutes,

the surgeon again told him to bend it a little more, and upon the same

conditions; and so on, until, in a very short space of time—perhaps

eight or ten minutes—the arm had been completely bent. The boy had

been alarmed, and the muscles had become so sensitive that they held

the parts with the most painful tenacity; but, beyond this, there was

nothing the matter.

We cannot help thinking that Abernethy's benevolence had a great

influence in directing some of his happiest contributions to practice.

We consider that every sufferer with that serious accident, fracture

of the neck of the thigh bone within the joint, owes a great portion

of any recovery he may have, to Abernethy. It was he who was the real

means of overthrowing a dangerous dogma, that such cases could not

unite by bone, and who opposed the practice consequent on it, by which

reparation by bone became impossible. There was hardly any subject

which he touched, of which he did not take some view more or less

original; and his reasoning was always particularly simple and to the

point. No man, we believe, ever exceeded him in the skill he possessed

in conveying ideas from one mind into another; but he did a great deal

more: those who really studied him were sent away thinking, and led to

work with a kind of pleasure, which was in some sense distinct from any

merely practical or professional interest.

He contrived to imbue you with the love of philosophical research

in the abstract—with an interest in truth for its own sake;

you found yourself remembering the bare facts, not so much from

conscious _efforts_ of memory, as from the suggestive interest of the

observations with which they were so frequently associated. In going

over one of his Lectures alone, they seem to grow and expand under your

own reflections. We know not how to express the effect they produced:

they seemed to give new pleasure on repetition, to purify your thoughts

scarcely less than they animated your onward studies.

In studying their more suggestive passages, you would now and then feel

surprise at the number and variety of important practical relations

arising out of a single proposition. We are here merely stating our

own early impressions of his power. What we always really felt was,

that, great as was the excellence of these Lectures in a scientific

or professional sense, there was something more excellent still in

the element they contained of intellectual expansion and of moral

improvement.

We cannot indeed say that they had no faults; but we should be hard

driven to point them out: and although we feel how short our attempt

to give some idea of his mode of proceeding must fall of doing him

justice, still, if there be any truth at all in our representation, it

is quite clear that his negative excellences alone must have implied

no ordinary powers. But we must conclude: "Quid multa? istum audiens

equidem sic judicare soleo; quidquid aut addideris aut mutaveris aut

detraxeris, vitiosius et deterius futurum."

[Footnote 68: Professor Macartney had also formerly given the

Anatomical Demonstrations.]

CHAPTER XXIV.

HOR. Is it a custom?

HAMLET. Ay, marry, is't:

But, to my mind, though I am native here

And to the manner born, it is a custom

More honoured in the breach than the observance.

HAMLET, Act I, Sc. IV.

If a moralist were to divide his catalogue of immoralities into such

as were of general commission, and such as occurred in the conduct of

the various trades and professions, we fear the latter division would

suggest no flattering position to humanity. An elevation somewhat above

gifted creatures it might be; but still we fear it would be at so low a

level as to afford Man but a humiliating indication of the height from

which he had fallen. He would, in too many instances, perhaps, find his

real _claims_ to his high destiny about equal to the shadowy difference

between a creature who fulfils _some_ only of his responsibilities,

and one who has no responsibilities to fulfil. We should like to hear

some grave philosopher discourse on Fashion: it is surely a curious

thing, for there is a fashion in everything. It is very like habit; but

it is not habit neither. Habit is a garment, which takes some time to

fit easily, and is then not abandoned without difficulty. Fashion is a

good fit _instanter_, but is thrown aside at once without the smallest

trouble. The most grotesque or absurd custom which slowly-paced

habit bores us with examining, is at once adopted by fashion with a

characteristic assentation.

Morals are by no means free from this kind of conventionalism: so

much the contrary, that few things evince more strongly the power of

fashion. It might be imagined that the multiplication of examples would

tend to teach the true nature of the thing exemplified; but it would

not seem so with error; "_tout au contraire_." Arts or acts, which are

tabooed as vicious in the singular number, become, in the plasticity of

our moral grammars, very tolerable in the plural. Things that the most

hardy shrink from perpetrating _single-handed_, are regarded as easy

"compliances with custom" when "joint-stock" vices; practices which,

when partial, men are penetrating enough to discover to be unchristian,

or sufficiently sensitive to regard as ungentlemanly, pass muster with

marvellous lubricity when they become universal. We can anathemize,

with self-complacent indignation, vices in which we have no share; but

we are abundantly charitable when we discuss those in which we have a

common property; and, finally, moral accounts are settled very much to

our own satisfaction, as Butler says, by compounding

"For sins we are inclined to,

By damning those we have no mind to."

After all, society keeps a pretty good "look-out" after offences

distributed in common. The law is tolerably comprehensive of things

which are of general commission; and mankind, sooner or later, contrive

to catch, or successfully oppose, the numerous little enormities which

slip through the finest of our legal meshes.

"Raro antecedentem scelestum,

Deseruit pede pœna claudo."

From all this it results that moral obliquities, which fall within the

observation of society, make but an up-hill game; that which is _felt_

to be prejudicial to the interests of all men, is easily determined

to be vicious. But here again there is much in fashion. Society has

often determined that the immorality of a thing is not to be measured

by the nature of the act, nor the motive even on which it has been

founded, so much as by the more refined test afforded by the _position_

of the _actor_. One man may, like a sort of commercial megatherium,

gorge, with railway velocity, provisions which a once-breathing, fond

affection and a cold world had alike determined to be the life-blood of

widows and orphans, and yet have noblemen and others for his associate!

he may perhaps be a legislator in a great nation; whilst the poor

starveling, who steals for the vulgar purpose of satisfying hunger, may

be sent to the treadmill, where he may solve at leisure the problem

thus set him, by "the most enlightened nation on earth."

Again, vices which have a known influence in disturbing the relations

of society are in various ways opposed by the more _public_ influence

of religion. So that in the end a man finds—although he may arrive at

the conclusion, only by exhausting all other views before he hits on

those which lead to it—that honesty is as good a way of getting on as

any other; or he may advance perhaps even on this utilitarian creed so

far as to agree with Tillotson: that people take more trouble to get to

Hell, than would suffice to carry them to Heaven. The immoralities of

trades and professions lie in a very different position, and involve

peculiarities which favour their growth and perpetuity.

They are committed in secret;—people are proverbially cautious of

attacking the weak positions of others, who feel that their own are

ill-defended. This, and the established manœuvres of each calling,

enable an individual to do a good deal "off his own bat," without, as

one of our bishops happily expressed it, "being caught out." In trade

we are sometimes informed that a thing cannot be sold cheaper; that the

price asked is already less than the cost; and people are appropriately

addressed as idiots, who every day appear to believe that which common

sense shows to be impossible.

Your purveyors will sometimes tell you that they are not living by the

prices they charge; although you have just ascertained that the same

article may be bought at infinitely less cost in the next market. The

other day, a watchmaker told us that our watch wanted a good deal of

looking to, and, amongst other things, "no doubt cleaning;" but this he

discovered, we suppose, by some recondite mesmeric process in a book,

which recorded when it had been cleaned last, without looking at the

watch at all.

As regards professions, lawyers are said to defend right and wrong with

indiscriminate avidity, with the encouraging prospect of obtaining more

fruit in maintaining one wrong cause, than establishing twenty right.

Then the _real nature_ of these things is, like too many in other

sciences, obscured by a cloudy nomenclature. We hear of "customs of

the trade," "secrets of the trade," or "profession," applied to things

which the moralist only recognizes under very different designations.

Sophisms thus secured, and which appear to minister to a man's

interests, have their true colours developed with difficulty; to say

nothing of it not being easy to discover that which there is no desire

to examine.

If any man should be so "peculiar," or "crotchety," as to consider that

names are of little import, and that "Vice is vice, for a' that," and

venture to anathematize any custom, or even refuse to be an accessory,

in declining to wink at it, he may encounter charges of violating

professional confidence, of being deficient in a proper _esprit de

corps_, and be outvoted, for no better reason than that he cannot

concur in the dogma, that a _vicious sophism is more valuable than a

simple truth_; nor agree with the currier, "that leather is the best

material for fortification." He may possibly be let off by conceding

his connivance; which is little better than declining to be thief, as

too shocking; but having no objection to the more lubricated position

of the receiver.

But does any one for one moment believe that all this can be hung

on any trade, or profession, with no effect? Or that it will not

have a baneful influence on every calling, and that in proportion

as its _real_ and _proper_ duties are beneficent and exalted? Now,

whilst we claim for the medical profession a character which, in its

single-mindedness and benevolence, yields to no other whatever, we fear

it is not entirely free from these technical besettings.

In the medical profession, we trust, that which we, for want of a

better term, designate as technical immoralities are exceptions.

Exceptional they may be, and we sincerely hope they are; but, in

a crowded island, exceptions, even if _relatively_ few, may be

_absolutely_ numerous; and whenever they occur, especially if men hold

any position, one case of compromise of duty does more harm than a

hundred of the most inflexible adhesions to it can remedy. Suppose a

patient apply to a surgeon with a complaint requiring one operation,

and his fears incline him to another; he is informed it is improper for

his case: that so far from relieving him, it will indefinitely increase

his sufferings. The patient reiterates his wishes; the surgeon declines

doing that which he would not have done in his own person. On lamenting

what he believes to be the consequences of the patient's determination,

to a brother surgeon, he is met by: "What a fool you must be to throw

away —— guineas; if you don't do it, somebody else will."

He is too right in his prediction, and so is the surgeon who refused

to operate, and he has lost a large fee; he receives the verification

of his prediction subsequently from the patient, who exclaims, "Sir,

I never have a moment's ease!" and when, after weeks of suffering,

the patient dies, the surgeon consoles himself with the melancholy

satisfaction of not having contributed to sufferings which he was

called in too late to remedy.

The more plastic practitioner has, it is true, taken fifty or a hundred

guineas, it may be, out of the one pocket, and put it into his own; but

in what way are mankind benefited? or does any one really think that

the apparent gainer can ultimately be so? The fault in this, as in many

other cases, is the ignorance of the public. There is nothing in the

foregoing sketch that was not as easily intelligible to the commonest

understanding, as that two and two are equal to four! And is it no evil

that one man should pay so large a sum for so plain a piece of honesty?

or that another should be rewarded, as the case may be, for ignorance,

or a compromise of his duty?

Let us take another case. A gentleman was called on to give a

certificate; he examined the case, and found that the wording of the

certificate called on him to certify to that which was diametrically

opposite to the fact. He naturally declined, and, as the point was of

some importance, went to the parties to explain. He was then informed

that two professional men had, the previous day, given the certificate

without hesitation. He is complimented on his conscientiousness,

but never employed again by that family; and he has the further

satisfaction of hearing that his place is supplied by one of his

more accommodating brethren! We fear that in such a case there is a

balance to be adjusted between the several persons, and an appropriate

appellation to be discovered besides. We respectfully leave it to the

reader's judgment to adjust the one, and to draw on his aptitude for

nomenclature to supply the other.

Again, a man is called in to a consultation; he disapproves of the

treatment, but declares to the friends of the patient that every thing

has been very properly done. In another case of consultation, finding

that every thing has been really conducted properly, he commences an

_apparently_ different treatment, but essentially the same, without

giving his confiding brother the benefit which his acquiescence in his

views would necessarily imply.

In an operation, where the course is doubtful and the opinion various,

the choice is left to the patient—that is, the decision of how the

surgeon is to act is to be determined by him who is confessedly really

least capable of judging. Can it be right to perform a _doubtful_

operation under such circumstances? Should not the patient reflect

that the _temptations_ are all on one side? The attempt to dispense

with the operation is laborious, time-consuming, anxious, encouraged

perhaps only by small, minute accessions of improvement, interspersed

with complaints of tedium and delay, and the result admitted to be

doubtful; the operation, on the other hand, is a work of a few minutes,

the remuneration munificent, the _éclat_ productive, and the labour

nothing. All this and much more no man can entirely prevent; the real

cause is the ignorance of the public, which a very little of the labour

they bestow on many far less important subjects would easily and

quickly dispel.

If these and multitudes of similar things are evils; if they contribute

to debase a profession and to charge the conscientious with unthankful

office and unrequited labour, and to confer fame and profit on a

triumphant chicanery; we surely must feel indebted—not only as

professional men, not merely as patients, but in a far higher and

wider sense—to a man who, availing himself of a commanding position

for the highest purposes, endeavoured, by precept and example, to

oppose all such proceedings, and to cultivate a high _morale_ in the

conduct of the profession. Now no one more sedulously aimed at this

than John Abernethy. Although we shall not, we trust, be accused of

underrating the obligations we owe him in a professional or scientific

sense, we think that, great as they are, they are at least equalled

by those arising out of that duty-to-your-neighbour spirit which was

so universally diffused through every thing he taught, and which, in

his intercourse with his pupils, he never on any occasion failed to

inculcate. We will endeavour to render what we mean intelligible, and

perhaps we cannot do this better than by selecting a few illustrations

from observation of "Abernethy in Consultation."

CHAPTER XXV.

"Hoc autem de quo nunc agimus id ipsum est quod utile

appellatur."—CICERO.

Consultation. We are to have a consultation! What a sound is that! How

many a heart has been set thumping by this one word. We doubt whether

there be any in the English language that has more frequently disturbed

the current it was intended to calm. But consultations must be. Already

the carriage of a physician has arrived, a tremendous rap has been

given at the door, the interesting visitor is already in the library.

Another rap, louder somewhat than the former, announces another

physician, or a consulting surgeon. The general practitioner,

taking advantage of his intimacy with the family, may have perhaps

very sensibly walked in without knocking at all. They are now all

assembled in the library, and, having remarked on a "Storm Scene" by

Gaspar Poussin, which hangs over the fire-place, we leave them to the

preliminaries of a consultation.

Presently they are introduced to the patient, on whom the knocking has

already had some effect. A short pause, and they are again assembled

in the library. In a few minutes the bell rings, and the father of a

fine young woman is summoned to hear their decision. As he proceeds,

he stealthily removes a straggling tear that, with all care, would

get out of bounds, enters the library, and hears the result of the

consultation. Neatly enveloped _honoraria_ are presented to the

consultants, the bell has rung, Thomas has shown the gentlemen to their

respective vehicles, and and so ends the consultation.

The father, a widower, returns to the drawing-room, and his second

daughter says: "Well, papa, what do the doctors say of Emily?" "Well,

my dear, they say that Emily is very ill; that she requires great

care; that they cannot say positively, but hope she may ultimately do

well. They entirely coincide with our friend Mr. Smith Jones as to the

nature of the disease, and think his treatment of the case has been

highly judicious. They say there are some points on which the case may

turn, but of which they cannot speak positively to-day; but they hope

to be able to do so when they meet again, which they are to do the day

'after to-morrow.' They all seem to consider the nervous system very

much affected. They say we must keep Emily very quiet. She is to have

any light diet she desires, and to have some new medicine to-morrow.

The cod-liver oil, they say, has done her all the good now that it is

calculated to do, and she is this evening to take a composing draught."

The family are silent, and so ends the consultation.

What! and are all consultations like that? No, reader, we hope not.

Many a valuable life has, we believe, been saved or prolonged by

consultation; and perhaps many more would be, if people would only

_think a little more before_ they act in such important matters.

But how is this to be, when men and women who _do_ think will dive into

all other branches of knowledge, more or less, and neglect all inquiry

into laws, a _general_ knowledge of which may easily be acquired, and

of which ignorance is so frequently visited by no less punishment

than the premature separation of our dearest ties, and the loss or

impairment of that which is acknowledged to be the first of temporal

blessings. There are many things in consultations, which require

putting right, which do not depend on any one man, or on any one class.

What are we to say to a man who admits the ability, and approves of

the investigative power and practice of another, but who cannot call

him in because he _orders so little medicine_? Or of the mode in which

the public treat another, who, wishing to practise as a gentleman, and

to be paid for his brains rather than his bottles, makes no charge for

the latter; and yet who informed us that, having tried this for three

years, he lost so many families by it, that if he had not relinquished

the plan, he should have wanted bread for his own? Or who shall we

blame, when one man, calling in another to a patient, finds that the

other feels no scruple in repaying the _prestige_ which he thus owes

to his confiding brother by taking the patient from him the first

opportunity; albeit that he occupies what should be, and, we trust, as

the rule is, a higher walk in the profession.

We have seen so much feeling arising from this practice, and we hold it

as so serious an error, that we regard it as _tending more than any one

thing whatever_ to injure the position and character of the consulting

branches of the profession.

Again, how inconsiderate must be the adoption of that custom which

first of all institutes an inquiry to ascertain whether there is

any difference of opinion, and yet accompanies it with trammels,

the tendency of which is to oblige men to _appear_ to agree. When

coincidence of opinion is _alone safe_, who can be expected to differ?

The public have allowed lawyers to differ without that difference

involving any reproach. They have also proverbially determined that

"doctors do." Yet that which they consider as an almost necessary

rule in the one case, in the other they are very prone to visit, in

regard to some one of the dissentients, as a proof of professional

inferiority. A great deal of mischief results from this state of

things; it indefinitely increases the difficulty of obtaining a _really

honest_ and unreserved opinion, and leads to other consequences which

tend to impair that mutual confidence between man and man, which should

be the very life-blood of a fine profession.

We recollect a case, on the nature of which two surgeons were

consulted; and when the patient—a young lady—had been withdrawn, the

_father_ requested to know if there were any objection to his being

present at the conference. The surgeon to whom he seemed to address

himself said, "None on my part;" to which the other _seemed_ also

to assent. When the consultation was over, the surgeon who had thus

_seemed_ to consent addressed the other, saying: "If ever we meet

again, sir, our consultation must not be in the presence of the friends

of the patient." This was said in a tone to which the other had not

been accustomed; but, as a lady had just then entered the room, no

reply was made. The next morning, however, the gentleman was called

on to re-consider the tone in which he had thus addressed his brother

consultant, when a satisfactory explanation settled the matter.

Such things, however, are extremely disagreeable, and illustrate how

much more easy it is to go straightforward than by any zigzag route.

What! could not a father hear the honest opinion of two men concerning

his child, until results of the consultation had been shorn down,

certain parts thrown out, and the rest dovetailed together so as to be

made a symmetrical nondescript, adapted to the requisitions of a vulgar

conventionalism?

In another case, in a consultation on a disease as plainly scrofulous

as it was possible to be, the family attendant had pronounced that it

was _constitutional_, but _not_ scrofula. This was, it appeared, a

miserable assentation to the prejudices of the family, for the result

proved that he knew better. Nevertheless, a consultation had taken

place already with a very eminent surgeon, without the family being

any the wiser in regard to the nature of the disease. The case not

progressing, another surgeon was consulted, who, being asked what

he considered the disease to be, replied that it was scrofula. Upon

this, considerable surprise and uneasiness were manifested on the part

of the family; and the surgeon, wondering what, in so plain a case,

could be the doubt, took occasion to see the former medical attendant,

and to ask him what he thought of the case; when he said that it was

clearly scrofula, and that he had _never known the children_ of certain

temperaments to which he considered the parents to belong, wholly

without a tendency to that disease; so that he had all along been

blinding the parents, so far as his opinion and that of another eminent

man went, to the real nature of the malady.

An occurrence, singular, as we hope, took place one day in

consultation, showing how comfortably the most questionable things

may appear to sit on a man's conscience, if only supported by some

_supposed_ sanction from custom. Two surgeons met to consider a case.

They differed as to its nature and treatment; as thus—the one thought

a certain remedy necessary, and that any prospective consequences on

its employment merged into the necessity of the moment; the other

thought that remedy wholly unnecessary, and therefore held even the

_possibility_ of any prospective mischief, an insuperable objection to

its use; conceding, however, that it _might_ possibly, if the treatment

were conducted cautiously, be so managed as to secure the patient

from the consequences in question; and that, if the patient preferred

that course, after the matter had been fairly stated to him, he would

superintend the plan.

Having retired into another room to consult, they were now again

introduced to the patient, when the junior was somewhat startled to

hear his senior begin thus: "Well, sir, we have considered your case,

and we perfectly agree as to the nature of it." Thinking that this

unexpected exordium might possibly be preliminary to some explanation

of the points on which they differed, the surgeon waited a minute to

hear what followed; but finding that his brother was irremediably

misrepresenting the matter, he said: "Stop, let us understand each

other!" and then stated what had really happened, and the exact nature

of their respective opinions; on which the other, in the coolest manner

possible, said: "Yes—exactly, you are quite right!" and so ended the

consultation.

There is, no doubt, some fault on all sides. The public are too

uninformed on these important subjects, and therefore do much that

is equally against their own interests and the preservation of that

dignity and respect which should ever attach to a high-missioned

profession. But is the profession itself free from blame? Do they

never themselves minister to this wretched system of double dealing?

We fear there is but one answer to this question. We are not careful,

for obvious reasons, to multiply examples of such things; but we are

convinced that there must be a change; and since the profession cannot,

as too many of the public may, plead ignorance—for this and a thousand

other reasons, they should lead the way. We only claim for ourselves

what we readily concede to others—the expression of our opinion—when

we say that consultations should be _bonâ fide_ examinations of the

case, and should be followed by _bonâ fide intelligible_ explanations

of it to the _patient_ or his _friends_, according to the obvious

suggestions of prudence or humanity in the individual case. When the

treatment is correct, the most honest proof should be afforded of it;

namely, the continuance of the plan of the attendant in ordinary,

unobscured by the farce or form of a prescription; or, if _additional_

appliance only is adopted, in such a case its subordinate character

should be honestly explained.

Where there is difference of view, if it be material, that also should

be candidly stated; and if this be done with _real fairness_, our

experience has convinced us that it may be effected without damage

to either party. In other differences of opinion, the public never

think it necessary to impute ignorance or incapacity: let them, _for

their own sakes_, repudiate this construction in regard to the medical

profession. Lastly, let them for ever abandon the practice of paying

any man for his bottles, the number of which will often be an inverse

ratio with his skill and judgment.

To return to Abernethy. No doubt his manner varied in consultation; but

of "Manner" we shall speak in a separate chapter. We will here record

our impressions as to "Abernethy in consultation;" the conditions

which seemed to secure a considerate opinion from him; the good sense

and reasonableness of those conditions; the practical result of the

observance of them, and the effect they were calculated to produce on

the public, in giving to consultations that efficiency by which they

should be characterized—an efficiency which _every one_ begins to

perceive to be necessary, and which must be equally to the advantage of

the public and the elevation of the profession.

CHAPTER XXVI.

"Quidquid enim justum sit id etiam utile esse censent; itemque quod

honestum idem justum, ex quo efficitur, ut quidquid honestum sit

idem sit utile."—CICERO.

The first thing, in consulting Abernethy, if you were a medical man,

was to be clear, and "well up" in the nature of the case; and the next

thing, not to state any opinion, unless you were prepared to give a

good reason for it. These conditions premised, we never saw any one

more unaffectedly deferential to the opinion of another.

A surgeon took a serious case to him, in which the question was as to

the removal of a large tumour in the neck, which seemed to be acquiring

connections of such depth and importance as to threaten (should that

step be desirable) to render the removal of it impossible. The patient

was advised to allow his surgeon in ordinary to state his case, and to

interrupt him only if he omitted anything in regard to it within the

patient's knowledge. This was done; the general habits of the patient

described, with the difference which had existed antecedent to the age

of thirty, and subsequently thereto. Mr. Abernethy examined the tumour.

To the SURGEON. It is parotid, is it not?

SURGEON. I think not, sir.

ABERNETHY (_hastily_). Why not?

SURGEON. Because, sir, reflecting on the depth and situation of the

parotid gland, I should hardly expect the tumour to be so moveable.

ABERNETHY. Ah, I see! Very well. (Then to the patient). Well, sir,

I should advise you to attend to your general health, and continue

to follow Mr. ——'s advice on that subject. What I say is—— (Then

followed a short lecture on the digestive organs.)

PATIENT. Do you think, sir, I shall get rid of it?

ABERNETHY. Nay, I cannot tell that. But now suppose you pursue a plan

steadily, say for a month, and the tumour does not increase, will it

not be encouraging to you?

PATIENT. Certainly, sir.

ABERNETHY. Well, then, try it; for if its removal should become

necessary, you will at least be in better condition for the operation.

If it does not get larger, or otherwise inconvenience you, let it alone.

The patient had heard so much of Abernethy's roughness, that he came

away equally pleased and astonished.

A surgeon took a Colonel in the army to him, with a case which was

progressing fairly, but, as he conceived, in consequence of the patient

not paying so much attention to his health as he was recommended to do,

not so satisfactorily as he desired. The Colonel briefly stated his

case.

ABERNETHY. Show me your tongue. Ah! that is bad enough.

COLONEL. You are quite right there.

ABERNETHY. Well, man, I don't require to be told that.

Here the surgeon stated the treatment, which had, in addition to

attention to the general health, involved some local administrations,

of which, in general, Abernethy approved, but, as it would seem, not in

this case. His difference of opinion he thus stated, in the presence of

the patient:

"Well, I say that there is a sufficient disorder of your digestive

organs to maintain the annoyances of which you complain; and I should

confine my attention to endeavour to put that disorder right. Mr. ——

seems to think that, in adding to this treatment the plan he proposes,

he will shorten the case. Well, that may be so; he has paid, I know,

a good deal of attention to this subject; and if I had one of my own

family ill with this complaint, I should feel perfectly satisfied, if

they were under his care. At the same time, I say what I think; and if

you do not find the general plan successful, then the means he proposes

might with propriety be added."

No harm resulted from this difference of opinion; but much benefit. The

patient was not pleased with Abernethy; but he thought him very skilful

and very honest.

One day, a surgeon went to him under the following circumstances. A

patient who had recently recovered from a lameness, which, as alleged,

had its cause in the foot, on a relapse went to another surgeon. This

gentleman had, as it ultimately appeared, hastily decided that the lady

had a complaint in the hip; she was therefore consigned to bed, and

treated for disease of that part. After about three months, feeling

no better, she desired to see the surgeon under whose care she had

formerly been.

The surgeon was now very much annoyed; for he found that he had been

by many persons charged with having mistaken the case, which he had

never even seen on the second attack, and which now presented a phase

in which disease of the hip, to a hasty examiner, might easily be

suggested. He was not much better satisfied, when, after a careful

examination of the case, he felt convinced that there was no disease in

the hip, although the symptoms were more severe than ever. He declined

undertaking the case without a previous consultation with the surgeon

who had decided it to be a disease of the hip; but the patient being

immoveable in her opposition to this request, and offering any other

surgeon, or more, if required, her wishes were acceded to, and Mr.

Abernethy requested to visit the case. On going to the patient, the

surgeon explained to Mr. Abernethy the points at issue, but without

telling him to which view his own opinion inclined, or the positive

_dictum_ of his senior brother, a very eminent surgeon. "I shall,

therefore," said he to Abernethy, "feel particularly obliged to you,

sir, if you will examine the case for yourself."

When they were introduced to the lady, Abernethy said: "Well, now, I

should be very well satisfied with Mr. ——'s report of your case; but

he says I must examine the limb for myself: so here goes."—A somewhat

repulsive beginning to a delicate lady, perhaps; but nothing could

be more cautiously gentle than his examination. In conducting it,

he had avoided one test which usually _does_ give a little pain. The

other surgeon, deeming the decision to be very important, reminded him

of this test (raising the limb and striking the heel gently), which

he then proceeded to do with equal gentleness. "That will do," said

he. "Now, sir, shall we go into another room?" "No, sir," replied the

surgeon. "If you please, Mr. Abernethy, I should prefer your at once

telling the patient what is your opinion on the case."

He then declared his opinion; but, fearing he might injure one or other

party, with the following exordium: "Now, madam, we are all liable

to mistakes: there is no man living who does not make more or less;

and I am sure I make mistakes; therefore I may do so in my opinion

of your case. But for the life of me I cannot perceive that you have

any disease in your hip." He then gave a short, but most lucid view

of what he conceived to be the cause of her pain, and illustrated it

by referring to something which happened to himself in one of his own

severe rheumatic attacks. The result proved that he was quite right as

to his view of the case; the lady, by exercise and other means (which,

had the hip been diseased, would have only exasperated her complaint),

had a good recovery.

One very great charm in Abernethy in consultation was, that there was

no difficulty in getting him to speak out. Some men are so afraid of

being wrong, that they never give you the whole of their opinion in a

case involving any difficulty. It is so obscure, and followed up by so

guarded a prognosis, that it sometimes amounts to no opinion at all.

Even with surgeons who were very unobjectionable, Abernethy in his

best manner contrasted very favourably. We recollect being very much

struck with this when, very young, we had to meet Mr. Cline and Mr.

Abernethy, within a few days of each other, in the same case. Mr. Cline

was very kind to the patient, elaborately civil; nor was there anything

which could be fairly regarded as objectionable; but his manner was

too artificial; the contrast in Abernethy was very agreeable. The case

was serious, and (as we thought) hopeless. Abernethy, the moment he

saw it, had his sympathies painfully awakened. Having asked a few

questions, he, in the very kindest manner, said, "Well, I will tell you

what I would do, were I in your situation." He then proceeded to direct

how she should regulate her living, how avoid mischievous experiments,

and went into a rather lengthy series of directions, in the most

unaffected manner, without leaving the room, or having any private

consultation whatever. The lady, who was a distinguished person, and a

very accomplished woman, was exceedingly pleased with him.

His manner, as we shall by and by admit, was occasionally rough,

and sometimes rather prematurely truthful. One day, he was called,

in consultation, by a physician, to give an opinion on a case of a

pulsating tumour, which was pretty clearly an aneurism. On proceeding

to examine the tumour, he found a plaister on it. "What is this?" said

Abernethy. "Oh! that is a plaister?" "Pooh!" said Abernethy, taking

it off and throwing it aside. "That was all very well," said the

physician; "but that 'pooh' took several guineas out of my pocket."

On the other hand, he never failed to give the warmest and most

efficient sanction he could to what he conceived to be judicious

treatment on the part of a practitioner with whom he was in

consultation. Mr. Stowe has kindly sent me a very good example of this;

and it illustrates also another very valuable feature in a consultant:

the forbearance from _doing anything_ where nothing is necessary. A

gentleman had met with a severe accident, a compound dislocation of

the ankle, an accident that Abernethy was the chief means of redeeming

from habitual amputation. The accident happened near Winterslow Hut,

on the road between Andover and Salisbury, and Mr. Davis of Andover

was called in. Mr. Davis placed the parts right, and then said to the

patient, "Now, when you get well, and have, as you most likely will,

a stiff joint, your friends will tell you— 'Ah! you had a country

doctor.' So, sir, I would advise you to send for a London surgeon to

confirm or correct what I have done." The patient consented, and sent

to London for Abernethy, who reached the spot by the mail about two in

the morning. He looked carefully at the limb, and saw that it was in

a good position, and was told what had been done. He then said, "I

am come a long way, sir, to do nothing. I might indeed pretend to do

something; but as any avoidable motion of the limb must necessarily be

mischievous, I should only do harm. You are in very good hands, and

I dare say will do very well. You may indeed come home with a stiff

joint; but that is better than a wooden leg." He took a cheque for his

fee (sixty guineas), and made his way back to London.

Soon after this, an old clergyman, in the same neighbourhood, had a

violent attack of erysipelas in the head and arm. His family, becoming

alarmed, wrote up to his brother, who resided near Bedford Row, to

request Mr. Abernethy to go down and visit the patient. Abernethy said,

"Who attends your brother?" "Mr. Davis[69], of Andover." "Well, I told

him all I knew about surgery, and I _know_ he has not forgotten it.

You may be perfectly satisfied. I shall not go." Here, as Mr. Stowe

observes, he might have had another sixty guineas.

He always felt a great deal of interest about compound dislocations of

the ankle-joint; because of his conviction that amputation, then so

commonly resorted to, was unnecessary. He used to tell several cases in

his lectures. One of them we will briefly relate here. It was that of a

labouring man, who fell off a scaffold in his own neighbourhood; and,

amongst other surgeons, they had sent for Abernethy. When he got to

the house, he found, he says, "a poor wee man, lying on his mattress,

with a very complete compound dislocation of the ankle-joint. The joint

was completely exposed, and the torn skin was overlapping the edge of

the bone." He placed the parts in their natural position, and drew the

skin out of the rent; and when he had thus adjusted it, as he said, a

horrible accident looked as if there had been very little the matter.

"Do you think, sir," said the poor little man, "that this can ever get

well?" "Yes, verily," said Abernethy. "Do not be out of heart about

it; I have known many such cases do well." "Why, sir," said the man,

"they have gone for the instruments." "I now found," said Abernethy,

"that two other surgeons had seen him, and had determined that it was

necessary to amputate. I felt that I had got into an embarrassing

predicament, and was obliged to wait until these heroes returned. When

they arrived, and saw the man lying so comfortably, they seemed a

little staggered: but one of them said, 'Mr. Abernethy, you know the

serious nature of these accidents, and can you give us an assurance

that this will do well?' I said, 'no, certainly not; but if it does

not do well, you can have recourse to amputation afterwards, and my

surgical character is pledged no further than this. I give you the

assurance that no immediate mischief will come on to endanger the man's

life. You may wait and see whether his constitution will allow him to

do well.' I added: 'I feel that I am got rather into a scrape; so you

must allow me to manage it in my own way.' So I got splints, put up

the limb, varnished the plaister, and then told them about sponging

it continually, so as never to allow any increase of temperature. Now

there are two holds you have on a patient's mind—hope and fear; and

I make use of both. So I said, 'If you lie perfectly still, you will

do well; and if you move one jot, you will do ill—that's all.'" The

remainder of the case need not be given. The man recovered, and saved

his limb.

We have referred to that case because, though relating to a

professional matter, there is a moral in it. He might easily have saved

himself all the trouble he took, and on the plea of etiquette; but

the poverty of the man pleaded for his limb, and the impossibility in

such a case, of the imputation of any wrong motive, left free exercise

for the prevailing feature of Abernethy's character—benevolence. The

mention of the instruments secured to the poor man that _personal_

attention to details by Abernethy himself which a more wealthy patient

might not have so certainly obtained.

We have remarked before on his kindness to hospital patients; and

sometimes the expression of their gratitude would be very touching.

It is difficult or impossible to carry out Mr. Abernethy's principles

of practice with _perfect_ efficiency in the atmosphere of a large

hospital in a crowded city, yet the truth of his views would sometimes

be impressed by very extraordinary and unexpected results. We select

the following as an example, for reasons which will be suggested by

the narrative. We are indebted to Mr. Wood[70], of Rochdale, for the

illustration; and, as we should only mar the scene by any abbreviation,

we must allow him to tell it in his own manner:

"It was on his first going through the wards after a visit to Bath,

that, passing up between the rows of beds, with an immense crowd of

pupils after him—myself among the rest—that the apparition of a poor

Irishman, with the scantiest shirt I ever saw, jumping out of bed, and

literally throwing himself on his knees at Abernethy's feet, presented

itself. For some moments, everybody was bewildered; but the poor

fellow, with all his country's eloquence, poured out such a torrent

of thanks, prayers, and blessings, and made such pantomimic displays

of his leg, that we were not long left in doubt. 'That's the leg, yer

honnor! Glory be to God! Yer honnor's the boy to do it! May the heavens

be your bed! Long life to your honnor! To the divole with the spalpeens

that said your honnor would cut it off!' &c. The man had come into

the hospital about three months before, with a diseased ankle, and it

had been at once condemned to amputation. Something, however, induced

Abernethy to try what _rest_ and constitutional treatment would do for

it, and with the happiest result.

"With some difficulty the patient was got into bed, and Abernethy

took the opportunity of giving us a clinical lecture about diseases

and their constitutional treatment. And now commenced the fun. Every

sentence Abernethy uttered, Pat confirmed. 'Thrue, yer honnor, divole

a lie in it. His honnor's 'the grate dochter entirely!' While, at the

slightest allusion to his case, off went the bed clothes, and up went

his leg, as if he were taking aim at the ceiling with it. 'That's it,

by gorra! and a bitther leg than the villin's that wanted to cut it

off.' This was soon after I went to London, and I was much struck with

Abernethy's manner; in the midst of the laughter, stooping down to the

patient, he said with much earnestness: 'I am glad your leg is doing

well; but never kneel, except to your Maker.'"

The following letter, though containing nothing extraordinary, still

shows his usual manner of addressing a patient by letter:

"Sir,

"In reply to your letter, I can only say what I must have said to

you in part, when you did me the honour of consulting me.

"Firstly. That the restoration of the digestive organs to a

tranquil and healthy state, greatly depends on the strict

observance of rational rules of diet. My opinions on this subject,

which are too long to be transcribed, are to be met with at page

72, of the first part of 'Abernethy's Surgical Observations,'

published by Longman and Co., of Paternoster Row.

"Secondly. Upon keeping the bowels clear, yet without irritating

them by over-doses of aperient medicine.

"Thirdly. I consider the blue pill as a probilious medicine, and

only urge that the dose be such as to do no harm, if it fail to do

good, and then to be taken perseveringly for some time, in order to

determine whether it will not slowly effect the object for which it

was given. In gouty habits, carbonate of soda, &c., may be given,

to neutralize acidity in the stomach, with light bitters; but

the _prescription of medicines of this kind_, as also any advice

relative to the cold bath, must rest with your medical attendant."

Dated the 17th of September; as usual, with him, without the year,

which was about 1824.

It is obvious that very few professional letters are adapted for

introduction. This was one kindly sent us by Mr. Preston, of Norwich,

and was written to a gentleman in Yorkshire.

Few things were more pleasing or valuable in Abernethy, than his

modesty and his sense of justice. He knew his superiority well enough,

but he measured it—as Science shows us all should do—with reference

to what was still beyond him, and not by the standard afforded by the

knowledge of others. His sense of justice was, we think, never appealed

to in vain. The following letter has appeared to us significant in

relation to these points. Amid the peaceful glories of a useful

profession, there is nothing that sinks deeper or interests our regard

more, than a man, in the hour of success, remembering what is due to

others. We think this remark particularly applicable to the late Mr.

Tait, in the following case. The letter from Abernethy was obligingly

sent us by Mr. Tait's son and successor. The remarks with which Mr.

Tait concludes his case, are as creditable to the writer as to him whom

they were intended to honour.

We have stated that Mr. Abernethy had been the first to extend the

application of John Hunter's celebrated operation for the cure of

aneurism, to a vessel nearer the heart (the external iliac artery), on

which Mr. Abernethy placed a ligature in 1797. Mr. Tait, of Paisley,

had an extraordinary case of aneurism in both lower extremities, so

high up as to oblige him to place a ligature on the external iliac

artery on both sides of the body. The case occurred in an old dragoon,

and the two operations were performed at separate times, with great

judgment and with complete success. The case of course made some

noise, and was highly creditable[71]. In closing his account of the

patient, Mr. Tait observes: "The complete success which has attended

these operations, while, certainly, it affords me one of the highest

gratifications the practice of my profession can procure me, chiefly

affects Mr. Abernethy.

"Accident has placed under my care a case which, so far as I know, is

unparalleled in the history of surgery, and it has been cured; but I

have only put in practice what every surgeon of the day ought to have

done. When, thirty years ago, Mr. Abernethy formed the firm resolve

of cutting open the walls of the abdomen and seizing the external

iliac artery, he made a mighty step in advance, he formed an epoch in

the history of his profession. John Hunter, upon reflecting on the

hæmorrhage proceeding from the vessel below the sac, after an operation

in 1779, when Mr. Broomfield, 'for security,' had tied the artery three

or four inches above the aneurism, had probably the first glimpse at

his great improvement of tying the artery, in cases of aneurism, nearer

the heart. His eminent successor has extended the principles of the

illustrious Hunter.

"So firmly impressed was Mr. Abernethy with the certainty of ultimate

success, that, nothing daunted by the unfortunate issue of his two

first cases, he persevered, and at length successfully secured the

external iliac artery. His steps have been followed by a host, till at

length it needed but such a case as mine to add the finishing touch to

his well-earned fame. In doing justice to the merits of such men, we act

but the part of prudence; since, if we do not, indignant posterity will.

"Paisley, January, 1826."

The following is Abernethy's reply to a communication from Mr. Tait on

the subject, and couched in a tone, just in relation to Mr. Hunter,

modest and characteristic as regards himself.

"TO DAVID TAIT, ESQ.

"SURGEON, PAISLEY.

"Dear Sir,

"I have read your interesting case in the 'Edinburgh Journal,' but

have no comments to offer. I have therefore only to thank you for

the honourable mention you have made of me. The progress of science

has given us reason to confide in the anastomosing[72] channels

for carrying on the circulation. The only question necessary to

be decided was—would _large_ arteries heal when tied? Every case

confirmed that point, and therefore there was little merit in

perseverance. Nevertheless, I feel grateful for your good opinion,

and with congratulation and best wishes,

"I am, dear sir,

"Yours very sincerely,

"JOHN ABERNETHY."

"Bedford Row, July 14."

(Post mark 1826.)

The following portion of a note, necessarily mutilated by the

suppression of professional matter, we copy as a written evidence of

his not _in any way_ appearing to alter or add to a treatment which he

approved. It is written to a highly esteemed member of our profession,

Mr. Beaman, of King Street, Covent Garden. Mr. Beaman had sent a

patient alone to Mr. Abernethy, who, having seen him, gave him the

following note:

"My dear Sir,

"The patient says"—here the symptoms referring to the point to be

investigated are stated—"and if this be true, I have no wish * *

* * nor can I suggest better treatment than that which you have

adopted.

"Yours very sincerely,

"JOHN ABERNETHY."

(No date, post mark 1825.)

The following letter to Mr. Wood, of Rochdale, reiterates his opinion

on a very important disease, contraction of the gullet or œsophagus,

and conveys a practical truth, which, if we may judge from the cases

published in the periodicals, is just as necessary as ever. We allude

to the too officious use of instruments in this affection, a lesson

of Abernethy's, of the practical excellence of which Mr. Wood had

convinced himself by his own experience, as we ourselves have on many

occasions.

"My dear Sir,

"I think as you do with regard to the difficulty of swallowing. It

seems likely to be the effect of irritability of the stomach; and

if so, the _passing of instruments, however soft and well-directed

they may be_, is not likely to be beneficial.

"Indeed, I have seen so little good from such measures, that I

should feel reluctant to employ them until impelled by stronger

necessity than exists in the present case. Spasmodic affection

in the part is, as you know, exceedingly common, and _continues_

for a great many years without producing permanent contraction.

With respect to the main object of the treatment of this case, I

cannot say more than you are already acquainted with, and which is

suggested at page 72.

"I have of late been personally convinced of the benefit of the

strictest attention to diet. Last summer, my stomach was so

disordered that it would not digest any thing, and I was constantly

tormented by the chemical changes which the food underwent in that

organ. I had scarcely any flesh on my bones, and sometimes every

ten minutes was seized with rheumatic spasms, which were as general

and severe as those of tetanus[73]. I went into the country, where

I could get good milk and eggs, and lived upon three ounces of

baked custard taken three times a day, drinking, four hours after

each meal, some boiled water that had been poured upon a small

quantity of ginger. Upon this quantity of food I regained my

flesh, and uniformly got better as long as I continued this plan

of diet, which was but for one month, for then I returned to town.

From the very first day, I had no more of these spasms. As for

medical treatment, I repeat that I cannot say more than you already

know. It gives me pleasure to find that you are settled to your

satisfaction.

"I remain,

"My dear Sir,

"Very sincerely yours,

"JOHN ABERNETHY.

"Bedford Row, January 9."

[Footnote 69: A very early pupil of Abernethy's. Mr. Davis was many

years in the army, and afterwards practised with great credit and

success at Andover. Late in life, he retired to Hampstead, where he

died at an advanced age, about four years since.]

[Footnote 70: The interesting letters of Mr. Wood and Mr. Stowe

were placed beside each other, and, in selecting extracts, in the

first edition, Mr. Stowe's name occurred in this place instead of

Mr. Wood's—a mistake for which we beg these gentlemen to accept the

assurance of our regret.]

[Footnote 71: Edinburgh Medical and Surgical Journal, vol. xxvi.]

[Footnote 72: The name applied to the collateral branches which carry

on the circulation when the main artery of limb is tied or obstructed.]

[Footnote 73: Locked-jaw.]

CHAPTER XXVII.

OF MANNER.

"Non ego paucis,

Offendar maculis, quas aut incuria fudit,

Aut humana parum cavit natura."

HORACE.

"I will not be offended by a few blemishes, the result of

inattention, or against which human frailty has not sufficiently

guarded."

Mankind have long established, by universal consent, the great

importance of "Manner." It has been so ably and so variously discussed

by different writers, that it is next to impossible to say any thing

new on the subject, or what has not been even better said on the

subject already. Still it is equally true that it is a thing very much

less cultivated than its influence demands; so that really easy, good

manners continue to be a very rare and enviable possession. But if

manner be thus influential in the ordinary intercourse of life, it is

still more important in ministering to disease. People, when they are

ill, have, for the wisest purposes, their susceptibilities more vivid;

and it is happy for them when those in health have their sympathies—as

is natural, we think, that they should be—quickened in proportion.

No doubt it is a great subtraction from whatever benefit the most

skilful can confer, if it be administered in a dry, cold, unfeeling, or

otherwise repulsive manner. There is too a very sound _physiological_

as well as _moral_ reason for kindness. It is difficult to overrate

the value of that calm which is sometimes diffused over the whole

system by the impression that there is an unaffected sympathy in our

sufferings. We have of course, in our time, observed abundant varieties

of manner in our professional brethren; and we have often listened with

interest to conversations in society, in which the manners of various

medical men have been the subject of discussion, from which good

listeners might, we think, have often taken valuable lessons.

We are convinced that the disguise, worn by some, of an artificial

manner, leaves, on many occasions, no one more deceived than the

wearer. Many patients have their perceptions remarkably quickened

by indisposition, and will penetrate the thin veil of any form of

affectation much more readily than people imagine. In common language,

good feeling and kind manner are said to spring from the heart. If a

man feels kindly, he will rarely express himself otherwise, except

under some momentary impulse of impatience or indisposition.

There is no doubt that the secret of a kind and conciliatory manner

consists in the regulation of the feelings, and in carrying into the

most ordinary affairs of life that principle which we acknowledge as

indispensable in serious matters—of doing to others as we would they

should do to us.

We are not speaking of a _polished_ manner; that is another affair.

A man's manner to a patient may be unpolished, or as homely as you

please; but if he really feels a sympathy for his patient, it will,

with the exception to be stated, never be coarse or unkind.

Some men are absurdly pompous; others, hard and cold; some put on a

drawling, maudlin tone, which the most superficial observer detects

as being affected. An honest sympathy is more acceptable than even a

polished manner; though doubtless that is a very desirable grace to a

learned profession.

In general, our own experience—and we know something of indisposition

in our own person—has induced us to judge favourably of the manner of

medical men.

There are, no doubt, exceptions, and sometimes in men in whom you would

least expect it. We have known men "eye" a patient, as if looking at

some minute object; some, jocosely familiar. One man has an absurd

gravity; another thinks he must be all smiles. We have known, too, the

adoption of a tone characterized by a sort of religious solemnity.

These, when assumed, are generally detected, and of course always

vulgar. Some even say really rude and unfeeling things, before any

thing has happened to provoke them. We attended a gentleman who had a

great deal of dry humour, and who was very amusing on such matters. One

morning, he said, "I saw Dr. —— on one occasion, and the first thing

he said to me I thought he might as well have omitted. 'I see, sir,'

said he, 'that you have taken the shine out of your constitution.'"

Abernethy's manner was at times—always, in serious cases, and, so far

as we ever observed, to hospital patients—invariably, as unaffectedly,

kind as could be desired. It is too true that, on many occasions of

minor import, that impulsiveness of character which we have seen in

the boy, was still uncontrolled in the man, and led him to say things

which, however we may palliate, we shall not attempt to excuse.

It is true his roughness was very superficial; it was the easiest thing

in the world to develop the real kindness of heart which constantly lay

beneath it; and it is very instructive to observe how a _very little

yielding_ to an infirmity may occasionally obscure one of the most

benevolent hearts that ever beat in a human breast, with the repulsive

exterior of ungentle manners. Still, patients could not be expected

to know this; and therefore too many went away dissatisfied, if not

disgusted.

The slightest reaction was, in general, sufficient to bring him to

his self-possession. A lady, whom he had seen on former occasions,

was one day exceedingly hurt by his manner, and burst into tears. He

immediately became as kind and patient as possible, and the lady came

away just as pleased as she had been at first offended.

Reaction of a different kind would answer equally well. One day, a

gentleman consulted him on a painful affection of his shoulder, which

had been of a very excruciating character. Before he had time to enter

on his case, Abernethy said, "Well, I know nothing about it." The

gentleman sharply retorted: "I do not know how you should; but if you

will have patience till I tell you, perhaps you then may." Abernethy at

once said, "Sit down;" and heard him out, with the greatest kindness

and patience.

I am indebted to Thomas Chevasse, Esq. of Sutton Coldfield, Warwick,

for the following letter to a patient in Surrey, who had complained

that he did not receive any sympathy from him.

"Dear Sir,

"I am sorry to have said any thing that has offended you. I may

have felt annoyed that I could not suggest any plan of treatment

more directly curative of your malady, and expressed myself

pettishly when you did not seem to understand my meaning; for I

am a fellow-sufferer, and had tried what are considered to be

appropriate remedies, unavailingly. I assure you that I did not

mean to hurt your feelings, and that I earnestly hope the state of

your health will gradually improve, and that your local maladies

will decline in proportion.

"I am, dear Sir,

"Your obedient servant,

"JOHN ABERNETHY.

"Bedford Row, October 25."

A surgeon was requested to visit a patient in one of the suburbs of

the metropolis. When he arrived there, he had to mount two or three

dilapidated steps, and to read a number which had been so nearly worn

away, that he was enabled to determine whether it was the number he

sought only by the more legible condition of its two neighbours. Having

applied a very loose, dilapidated knocker, an old woman came to the

door.

"Does Captain —— live here?"

"Yes, sir."

"Is he at home?"

"Yes, sir. Please, sir, may I be so bold—are you the doctor, sir?"

"Yes."

"Oh! then, sir, please to walk up."

The surgeon went up a small, narrow staircase, into a moderate-size,

dirty, ill-furnished room, the walls of which were coloured something

between yellow and red, with a black border. An old man, in a very

shabby and variegated _deshabille_, rose from his chair, and, with

a grace worthy of a court, welcomed the stranger. His manner was

extremely gentlemanly, his language well chosen, the statement of his

complaint particularly simple and clear. The surgeon, who, like most

of us, sees strange things, was puzzled to make out his new patient;

but concluded he was one of the many who, having been born to better

things, had been reduced by some misfortune to narrow circumstances.

Everything seemed to suggest that construction, and to warrant no

other. Accordingly, having prescribed, the surgeon was about to take

his leave, when the old gentleman said:

"Sir, I thank you very much for your attention;" at the same time

offering his hand with a fee.

This the surgeon declined, simply saying:

"No, I thank you, sir. I hope you will soon be better. Good morning."

"Stay, sir," said the old gentleman; "I shall insist on this, if you

please;" in a tone which at once made the surgeon feel that it would

be painful and improper to refuse. He accordingly took it. The old

gentleman then said, "I am very much obliged to you, sir; for had

you not taken your fee, I could not again have the advantage of your

advice. I sent for you because I had understood that you were a pupil

of Mr. Abernethy's, for whom I could not send again, because he would

not take his fee; and I was so hurt, that I am afraid I was almost rude

to him. I suppose, judging from the appearance of things here that I

could not afford it, he refused his fee; on which I begged him not to

be deceived by appearances, but to take it. However, he kept retreating

and declining it, until, forgetting myself a little, and feeling

somewhat vexed, I said, 'By G—, sir, I insist on your taking it!' when

he replied, 'By G—, sir, I will not!' and, hastily leaving the room,

closed the door after him."

This gentleman has been dead some years. He lived to a very advanced

age—nearly, if not quite, ninety—and had many instructive points of

character. He was really in very good circumstances; but he lived in

a very humble manner, to enable him to assist very efficiently some

poor relations. To do this, he saved all that he could; and although

he insisted on the surgeon taking a fee when he visited him, he said

that he should not hesitate to accept his kindness when he called on

the surgeon. The intercourse continued many years; but with rather a

curious result.

After a time, growing infirmities converted what had been a

visit—perhaps once or twice a year—into occasional attendances,

when the rule he had prescribed to himself, of paying visits at home,

became characterized by very numerous exceptions; and, at last, by so

many, that the rule and the exception changed places. The surgeon,

however, went on, thinking that the patient could not do other without

disturbing existing arrangements. When, however, the old gentleman

died, about four hundred guineas were found in his boxes, wrapped up,

and in various sums, strongly suggestive of their having been (under

the influence of a propensity too common in advancing life) savings,

from the somewhat unnecessary forbearance of his medical attendant. We

know one other very similar occurrence.

Sometimes Mr. Abernethy would meet with a patient who would afford

a useful lesson. A lady, the wife of a very distinguished musician,

consulted him, and, finding him uncourteous, said, "I had heard of your

rudeness before I came, sir; but I did not expect this." When Abernethy

gave her the prescription, she said, "What am I to do with this?"

"Anything you like. Put it in the fire, if you please."

The lady took him at his word—laid his fee on the table, and threw

the prescription into the fire, and hastily left the room. Abernethy

followed her into the hall, pressing her to take back her fee, or to

let him give her another prescription; but the lady was inexorable, and

left the house.

The foregoing is well-authenticated. Mr. Stowe knows the lady well, who

is still living. But many of these stories, to our own knowledge, were

greatly exaggerated. Abernethy would sometimes offend, not so much by

the manner as by the matter; by saying what were very salutary, but

very unpleasant truths, and of which the patient perhaps felt only the

sting. We know a gentleman, an old fox-hunter, who abused Abernethy

roundly; but all he could say against him was: "Why, sir, almost the

moment I entered the room, he said: 'I perceive you drink a good

deal,'" which was very true. "Now," added the patient, very _naïvely_,

"suppose I did, what the devil was that to him!"

Another gentleman, of considerable literary reputation, but who,

as regarded drinking, was not intemperate, had a most unfortunate

appearance on his nose, exactly like that which frequently accompanies

dram-drinking. This gentleman used to be exceedingly irate against

Abernethy, although all I could gather from him amounted to nothing

more than this, that when he said his stomach was out of order,

Abernethy observed, "Ay, I see that by your nose," or some equivalent

expression.

However rough Abernethy could occasionally be, there was, on grave

occasions, no feature of his character more striking than his humanity.

Dr. Barnett[74] had a case where Abernethy was about to perform a

severe operation. The Doctor, at that time a young man, was anxious

to have every thing duly prepared, and had been very careful. When

Abernethy arrived, he went into the room into which the patient was to

be brought, and, looking on the instruments, &c. on the table, said:

"Ay, yes, that is all right;" then, pausing for a moment, he said: "No,

there is one thing you have forgotten;" and then, throwing a napkin

over the instruments, added: "It is bad enough for the poor patient

to have to undergo an operation, without being obliged to see those

terrible instruments."

Few people get off so badly in the world as poor gentlemen. There are

multifarious provisions in this kingdom for all sorts of claimants; but

a poor gentleman slips down between those which are not applicable

to his case, and those which are too repulsive to be practicable. His

sensibilities remain—nay, perhaps are sharpened—and thus, whilst

they tend to exasperate his wants, they increase the difficulty of

supplying them. There is here afforded a grateful opportunity for the

indulgence of what we believe, amidst some exceptions, to be the ruling

spirit of medical men: a sensitive philanthropy, which no men in the

world are more liberal in disbursing. Abernethy had his full share of

this excellence. There are multitudes of instances exemplifying it.

We are indebted for the following to Mr. Brown, of the respected firm

of Longman and Co. Abernethy was just stepping into his carriage to

go and see the Duke of ——, to whom he had been sent for in a hurry,

when a gentleman stopped him to say that he should be very glad if

he could, at his leisure, pay Mr. —— another visit at Somers Town.

Abernethy had seen this poor gentleman before, and advised a course

which it appeared that the patient had not resolution to follow. "Why,"

said Abernethy, "I can't go now, I am going in haste to see the Duke

of ——." Then pausing a moment before he stepped into the carriage,

he looked up to the coachman and said, quietly, "Somers Town." This is

very characteristic. The fidgetty irritability of his first impression

at interference, and the beneficence of his second thought.

Dr. Thomas Rees knew a gentleman who was a man of ability, who had

been a long time ill, and who got a scanty living by his writings. Dr.

Rees called on Abernethy, one morning, and told him that the gentleman

wished to have his opinion; but that he had heard such accounts of him,

he was half afraid to see him. "And if he were not," said Dr. Rees, "he

is not able to pay you. He is a great sufferer, and he gets his living

by working his brains." "Ah!" said Abernethy; "where does he live,

do you say?" "At ——," mentioning a place full two miles distant.

Abernethy immediately rang the bell, ordered his carriage, visited the

gentleman, and was most kind to him.

One day, a pupil wished to consult him, and found him, about ten

minutes before lecture, in the museum, looking over his preparations

for lecture—rather a dangerous time, we should have said, for

consultation. "I am afraid, sir," said the pupil, "that I have a

polypus in my nose, and I want you to look at it." No answer; but when

he had sorted his preparations, he said: "Eh! what?" The pupil repeated

his request. "Then stand upon your head; don't you see that all the

light here comes from a skylight? How am I to look up your nose? Where

do you live?" "Bartholomew Close." "What time do you get up?" "At

eight." "That can't be then." "Why, sir?" "You cannot be at Bedford Row

at nine." "Yes, sir, I will." "To-morrow morning, then." The pupil was

punctual. Mr. Abernethy made a most careful examination of his nose,

entered into the causes and nature of polypi, assured him that there

was nothing of the sort, and exacted from him a promise that he would

never look into his nose again. The gentleman, in his letter to me,

adds: "This I have never done, and I am happy to say that there has

never been any thing the matter."

The following we have from a source of unquestionable authority:

Abernethy was attending a poor man, whose case required assistance at

a given time of the day. One morning, when he was to see this patient,

the Duke of York called to say that the Prince of Wales wished him to

visit him immediately. "That I cannot do," said Mr. Abernethy, "as I

have an appointment at twelve o'clock"—the time he promised to visit

the poor man. "But," said the Duke, "you will not refuse the Prince; if

so, I must proceed to ——." "Ah!" said Abernethy, "he will suit the

Prince better than I should." He was, however, again sent for, a few

hours later, when he of course visited the Prince.

Very many instances of his liberality were constantly occurring. The

following is a specimen:

The widow of an officer of limited income brought her child some

distance from the country to consult Abernethy. After a few weeks'

attendance, the lady having asked Abernethy when she might return home,

was told that she must remain some weeks longer, or he could not answer

for the well-doing of the case. In the meantime, having learned how

the widow was situated, he continued to take the fees, folding them up

in a paper. When he finally took his leave, he returned home, enclosed

the fees which he had received, with the addition of a cheque for £50,

with a kind note, saying, that as he understood her income was limited,

he had returned the fees, with an addition, which would enable her to

give the child, who could not walk, a daily ride in the fresh air,

which was important to her recovery.

He was, indeed, as it appeared to us, most liberal in the mode of

conducting his practice. When asked by a patient when he desired to see

them again, it was at the longest period compatible with a reasonable

observation of the case; and we doubt whether he ever took a fee where

he had even a _doubt_ as to the circumstances of the patient justifying

his so doing. It would be easy to multiply examples of this; but it

would be a constructive injustice to others to appear to bring things

out in high relief, or as _special_ excellences, which (notwithstanding

some exceptions) from our hearts we believe to be a prevailing

characteristic of the profession.

Abernethy had been, nearly all his life, without being improvident,

habitually careless of money; and, although he provided his family

with a comfortable competency, which very properly left their position

unaltered by his death, yet we doubt if ever any man, with the

opportunity of making so much, availed himself of that opportunity so

little.

Many instances occurred of his carelessness in these matters.

He used to put his not very slowly accumulating fees anywhere;

sometimes by the side of his portfolio; sometimes on a shelf in his

bookcase, between something else which might be there. When he retired

from Bedford Row, they found a considerable heap of fees which he had

placed in the bookcase and forgotten—an anecdote which shows that he

must have been making some way in practice as early as his marriage,

exemplifies this sort of carelessness, and suggests its impropriety. He

was in the habit, even then, of leaving his fees on his table in his

private room. He thought, on more than one occasion, that some had been

removed: he, however, said nothing; but, having taken means to assure

himself of the fact, he marked some fees and allowed matters to go on

as usual. Again missing fees, he waited till the whole party, which

consisted of pupils residing in the house, were settled at breakfast.

"Gentlemen," he said, "I must beg you to give me your purses." This was

of course immediately done. In one of the purses he found the marked

fees. This individual has been dead many years. He turned out, as may

be supposed, _badly_.

It had become the fashion in Abernethy's latter days to speak lightly

of him as an operator; and we have very little desire to rest any

portion of his reputation on this branch of our duty. Nevertheless,

when we first knew Abernethy, if we had had to be the subject of an

operation, we knew no man to whom we should have submitted with the

same confidence. He was considerate and humane; he did as he would

be done by; and we have seen him perform those operations which are

usually regarded as the most difficult, as well as we have seen them

ever performed by any body; and without any of that display or effect

too often observed, which is equally misplaced and disgusting.

His benevolent disposition led him to feel a great deal in regard

to operations. Like Cheselden and Hunter, he regarded them, as in a

scientific sense they truly are, the reproach of the profession; since,

with the exception of such as become necessary from accidents, they

are almost all of them consequent on the imperfection of Medicine or

Surgery as a science.

Highly impulsive, Abernethy could not at all times prevent the

expression of his feelings, when perhaps his humanity was most

earnestly engaged in his suppression of them. It was usually an

additional trial to him when a patient bore pain with fortitude.

One day, he was performing rather a severe operation on a woman.

He had, before commencing, said a few words of encouragement, as

was usual with him, and the patient was bearing the operation with

great fortitude. After suffering some seconds, she very earnestly,

but firmly, said, "I hope, sir, it will not be long." "No, indeed,"

earnestly replied Abernethy; "that would indeed be horrible."

In fact, he held operations as occupying altogether so low a place

in our duties, and as having so little to do with the science of our

profession, that there was very little in most of them to set against

that repulsion which both his science and his humanity suggested.

As he advanced in life, his dislike to operations increased. He was apt

to be fidgetty and impatient. If things went smoothly, it was all very

well; but if any untoward occurrence took place, he suffered a great

deal, and it became unpleasant to assist him; but he was never unkind

to the patient. It is, however, not always easy to estimate correctly

the amount of operative dexterity. Hardly any man will perform a dozen

operations in the same manner. We have seen a very bungling operator

occasionally perform an operation extremely well; whilst the very worst

operation we ever saw was performed by a man whose fame rested almost

entirely on his dexterity; and what made it the more startling, was

that it was nothing more than taking up the femoral artery. But whether

it were that he was not well, or had been careless _in the site_ of his

first incision, or in _opening the sheath_ of the vessels before he

passed his ligature, or all of these causes in conjunction, we could

not tell, because we were not quite near enough; but we never witnessed

a more clumsy affair.

The conditions calculated to ensure good operating, are few and simple;

there are _moral_ as well as medical conditions; and no familiarity

ever enables a surgeon, on any occasion, _safely_ to dispense with any

of them. When they _are all_ observed, operating usually becomes steady

and uniform; when _any_ of them are dispensed with or wanting, there is

always risk of error and confusion.

We are afraid that we should be hardly excused in a work of this

kind, were we to lay down the canons to which we allude. We cannot,

therefore, enter any further into the subject.

Previously to offering a few remarks on the causes of Abernethy's

occasional irritability, we must not omit to mention a hoax that was

played on him. He had been in particularly good, boy-like spirits, and

had proposed going to the theatre; where he had enjoyed himself very

much. On reaching home, there was a message desiring his attendance at

Harrow. This was a very unwelcome finale. The hoax had been clumsily

managed, but it did not strike anybody at the moment; so it was decided

that Mr. Abernethy must go; and he took Mr. Skey with him. When they

got to Harrow, they drove to the house of the surgeon, and, knocking

him up, the surgeon came to the window in his night-cap, when the

following dialogue began. The name of the patient we shall suppose to

be Wilson.

"Does Mr. Wilson live here?"

"Who are you?"

"I say, then, is Mr. Wilson living here?"

"I say what do you want? Who the d——l are you?"

"I say that I want to find a Mr. Wilson; and my name is Abernethy."

"Immediately," says Mr. Skey, "off flew the night-cap."

"I beg your pardon, Mr. Abernethy; what can I do for you," &c.

"Is there a Mr. Wilson living here; and has he broken his leg?"

"Oh, yes, sir, he is living here; but he is very well, and has not met

with anything of the kind."

Abernethy laughed heartily, and ordered the post-boy to drive him home

again.

There would be no difficulty in multiplying anecdotes given to

Abernethy; but there are some objections to such a course. In the first

place, there are many told of him which never happened; others, which

may probably have happened, you find it impossible to authenticate;

and, lastly, there is a third class, which, if they happened to

Abernethy, certainly happened to others before Abernethy was born. In

fact, when a man once gets a reputation of doing or saying odd things,

every story in which the chief person is unknown or unremembered is

given to the man whose reputation in this way is most remarkable.

We need not say how impossible it is, in a Memoir of this kind, to

introduce, with propriety, matters thus apocryphal.

We have no doubt that, with a most benevolent disposition, Abernethy's

manner, particularly as he advanced in years, evinced great

irritability; and we believe that it was the result of two or three

different causes, which, in their combined influence, got a mastery

which the utmost resolution was not at all times able to control. It

had formed the subject of numerous conversations between Abernethy and

some of his most intimate friends, and we believe had arisen, and been

unconsciously fostered by the following causes: "In early life, he had

been," as he told Dr. Thomas Rees, "particularly disgusted with the

manner in which he had seen patients caressed and 'humbugged' by smooth

and flattering modes of proceeding, and that he had early resolved to

'avoid that at all events.'" He further observed: "I tried to learn my

profession, and thinking I could teach it, I educated myself to do so;

but as for private practice, of course I am _obliged_ to do that too."

We can easily understand how, in a sensitive mind, an anxiety to avoid

an imputation of one kind might have led to an opposite extreme; and

thus an occasional negligence of ordinary courtesy have taken the place

of a disgusting assentation.

A temper naturally impulsive, would find in the perplexities which

sometimes beset the practice of our profession, too many occasions

on which the suggestions of ruffled temper, and of fear of improper

assentation, would unfortunately coincide; and thus tend to intermix

and confound the observance of a praiseworthy caution, with a yielding

to an insidious habit. If to this were now added that increase of

irritability which a disturbed and fidgetty state of physique never

fails to furnish, and from which Abernethy _greatly suffered_, the

habit would soon become dominant; and thus an originally good motive,

left unguarded, be supplanted by an uncontrolled impulse. We believe

this to have been the short explanation of Abernethy's manner; all we

know of him seems to admit of this explanation. It was a habit, and

required nothing but a check from his humanity or his good sense to

correct it; but then this was just that which patients were not likely

to know, and could have been still less expected to elicit.

Again, most men so celebrated are sure to be more or less spoiled.

They become themselves insensibly influenced by that assentation

which, when detected, they sincerely despised. The moral seems to be,

that the impulses of the most benevolent heart may be obscured or

frustrated by an irritable temper; that habits the most faulty may rise

from motives which, in their origin, were pure or praiseworthy; that

it is the character of Vice to tempt us by small beginnings; that,

knowing her own deformity, she seldom fails to recommend herself as the

representative, and too often to assume the garb, of Virtue; that the

most just and benevolent are not safe, unless habitual self-government

preside over the dictates of the intellect and the heart, and that the

_impulse_ to which _assent_ is yielded to-day, may exert the influence

of a command to-morrow; that, in fact, we must be masters or slaves.

"Rege animum qui nisi paret

Imperat."

The views which we have thus ventured on submitting, are verbatim

those which appeared in the former editions of these Memoirs, and,

consequently, were written long before we were favoured with the

following letter. It was written to his daughter Anne, before her

marriage with the late Dr. Warburton, dated Littlehampton, August 13,

and is remarkably corroborative of some of the preceding remarks.

"My dear Anne,

"Lack of employment is, as I believe, the cause of your receiving

this note in reply to the one I received from you by your mother.

Certain I am that I never thought of writing an answer till just

now, when it occurred to me that it would be polite to do so, which

very phrase had nearly prevented the intention. Why have all the

legitimate children of John Bull an aversion to politeness? 'Tis

because it so commonly covereth a multitude of sins; because, with

honest simplicity, they have often caught hold of the garb and

found that it concealed deformity and malice. I frankly acknowledge

that I may have carried my detestation too far, because it does not

necessarily follow that our best friends should not wear becoming

and fashionable apparel. I like to see them _en deshabille_,

however. 'Tis the man, and not the dress, I am concerned about.

I tell you, sincerely, that I take your note to be one of many

evidences of your having both a good head and heart. Other young

ladies would have spoken to mamma. Enough of this unprofitable chat.

"Yours ever,

"JOHN ABERNETHY.

"Little Hampton, 13th August."

When the editors of the medical periodicals first began to publish

the lectures given at the different hospitals, there was considerable

discussion as to the propriety of so doing. The press, of course,

defended its own views in a spirit which, though not always unwelcome

to readers, is frequently "wormwood" to the parties to whom the press

may be opposed.

We are not lawyers, and therefore have no claim to an opinion, we

suppose, on the "right;" but, as regards the general effect of this

custom _as now practised_, we are afraid (however advantageous it may

be to the trade to obtain gratuitously these bulky contributions to

their columns) that doubts may not be unreasonably entertained whether

it is of advantage to science, to the character of our periodical

literature, or the profession.

The publicity which it gives to a man's name, induces men to contribute

matter which it would often have been, perhaps, more advantageous to

them to have suppressed; and the proprietors, so long as a periodical

"pays," are not likely to quarrel with that which they get for nothing

but the expense of publication.

Mr. Abernethy was very much opposed to the publication of his lectures;

but, though not insensible by any means to the occasionally caustic

remarks of the press, he does not seem to have been much annoyed by them.

The following is an extract from a letter, in which he expresses

himself as opposed to the conduct of those who publish lectures

without the permission of the authors. We suppress that part, because

it involves his opinion of the conduct of individuals. As regards his

personal feelings, he says:

"Though I have been so long in replying to your letter, I have felt

very grateful for the kindness which induced you to take up the

cudgels in my behalf. At the same time, I must say that, had I been

at your elbow, I should have hinted to you that the object was not

worth the trouble you have been so good as to bestow upon it. No

one can expect to escape slander and misrepresentation; and these

are so commonly bestowed upon all, that they have little or no

influence on the minds of persons of character and judgment.

"With many thanks and best wishes,

"I remain, my dear sir,

"Yours very sincerely,

"JOHN ABERNETHY."

SECTION.

When Mr. Abernethy was appointed _surgeon_ to St. Bartholomew's

Hospital, in 1815, he had already been twenty-eight years assistant

surgeon, and was therefore fifty years of age before he had an

opportunity of taking an active share in the practical administration

of the Hospital. This is one of the many effects of a System of

which we shall presently give a sketch. He was thus invested with

the additional duties of Surgeon of the Hospital, and Professor to

the College of Surgeons, at a time of life when most people, who

have commenced young and laboured hard with their intellects, as

distinguished from their hands, begin to feel their work. This was

the case with Abernethy. We do not think that his original physical

organization was to be complained of; he had been active and energetic,

he was of moderate stature and well-proportioned; a magnificently

poised brain, judging phrenologically; and, in short (under favourable

circumstances), he appeared to have had the elements of long life; but

we think that his organization—and especially the presiding power, the

nervous system—was ill-adapted either for the air, the anxieties, or

the habits of a crowded city; or the somewhat pestilential atmosphere

of a dissecting-room.

We saw him, therefore, ageing at fifty very sensibly, and rather more

than is in general observable at that period. He complained, in 1817,

of the fatigue of the College lectures, coming, as they did, on the

completion of a season of the "mill-round" of hospital tuition and

practice. So that, when we mentioned the period of his lectures at the

College as on so many accounts the zenith of his career, there was

the serious drawback arising from a certain diminution of strength

which had never been, at best, equal to the _physical_ fatigue of his

multiform avocations. All this arose partly out of a System, which,

although, like all evils, not allowed to proceed without being charged

with elements of remotely prospective correction, has been the parent

of much mischief. This is what we have called the "Hospital System,"

some of the more important features of which we will now present to our

readers.

[Footnote 74: This gentleman, who retired some years since from

practice, died at Norwood, about a month ago, at the age of 73. Dr.

Barnett was born at Malmesbury, and was an early pupil of Abernethy's,

and a friend of Dr. Jenner's; he practised many years as a general

practitioner in Charter-House Square, where he realized, we believe,

a comfortable competency. He was distinguished by a singularly mild,

gentlemanly, and inoffensive bearing, not less than by the confidence

reposed in his skill and judgment by a large list of patients and

friends.]

CHAPTER XXVIII.

THE HOSPITAL SYSTEM.

"——Non hæc sine numine Divum

Eveniunt."

ÆNEID, lib. ii, 1. 777.

If we would view any human institution dispassionately, we must

distinguish the vices of System from the faults of those who administer

it.

Trite as this remark may be, the caution it involves is just that which

is too frequently overlooked or unobserved. By a careful attention to

the distinction it implies, we may develop the elements of rational

reform, as contrasted with Utopian schemes; which, whatever of abstract

truth they may contain, are frequently useless, simply because they are

impracticable. We cannot effect any material change in human nature

by any summary legislation, nor prevent the obtrusive necessities of

daily life from bringing down the soaring aspirations of mind, to the

humble level of the practicabilities of matter. Whoever, therefore,

expects that any body of men, invested with irresponsible power, will

hesitate to exercise it so as to procure, as they believe, the maximum

of advantage to themselves,—might just as hopefully quarrel with the

negro on account of his complexion. Do what you may, Man is Man "for

a' that;" but whilst it is necessary to remember this, it is by no

means so, to do it in a spirit of unkindness or hostility, nor in any

sense opposed to brotherly love; but, on the contrary, in a tone of

mind which, alike mild and uncompromising, desires to promote universal

harmony and good feeling, by removing the temptations which experience

has shown to be influential in disturbing such relations.

Neither should we quarrel with a man who endeavours to do the best

he can for his family and friends. Should he, even in this pursuit,

compromise his duty to the public, it is very _possible_ that the

objects which he had in view may have been in themselves praiseworthy,

and therefore, instead of exasperating our blame, may readily

_extenuate_ faults which it may be impossible to excuse.

The truth is, that the interests of the public and of individuals are

seldom, if ever, incompatible; the occasions on which they appear to be

so are not unfrequent; those in which they really clash are extremely

rare.

Wherever circumstances occur in which the temptation of a present

fruition is found habitually to lead men to courses which, however

apparently promotive of their own interests, are really detrimental to

those of the public,—it becomes very necessary that the public should

impose safeguards against such an injurious exercise of power.

The hospitals of London, as we formerly observed, are, in the main,

very fine institutions. They are many of them very wealthy, which

generally means powerful also.

The Governors, as they are termed, consist of certain noblemen and

gentlemen; the latter being, for the most part, drawn from the more

wealthy sections of the mercantile and trading classes.

The knowledge possessed by these gentlemen of the requisitions of

a large public hospital, must (special instances excepted) be very

measured; and be, in the main, derived from the medical officers with

whom they are associated.

It thus happens that the administration of the hospital is in great

part confided—as, with _some restrictions_, it ought to be—to the

medical officers. The interests of these gentlemen, it may be assumed,

would be best promoted by carrying out in the most efficient manner

the benevolent objects of the institution: and we believe, looked

at fairly and comprehensively, this would be really the case. The

duties of a large hospital, however—if they are to be performed

conscientiously—require much time, not a little labour, and some

health to boot. Now all these, in a crowded community, are very costly

articles; and which must, in justice—and, what is material, in fact

too—be fairly remunerated. The public never _really_ pay so dearly, as

when they _appear_ to get labour for nothing.

Here we come to the first defect in the "Hospital System."